Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke
Mujanovic, Adnan ; Strbian, Daniel ; Demeestere, Jelle ; Marto, João Pedro ; Puetz, Volker ; Nogueira, Raul G ; Abdalkader, Mohamad ; Nagel, Simon ; Raymond, Jean ; Ribo, Marc ... show 10 more
Citations
Authors
Strbian, Daniel
Demeestere, Jelle
Marto, João Pedro
Puetz, Volker
Nogueira, Raul G
Abdalkader, Mohamad
Nagel, Simon
Raymond, Jean
Ribo, Marc
Michel, Patrik
Yoshimura, Shinichi
Zaidat, Osama O
Winzer, Simon
Ortega-Gutierrez, Santiago
Sheth, Sunil A
Siegler, James E
Dusart, Anne
Haussen, Diogo C
Henon, Hilde
Serrallach, Bettina L
Mohammaden, Mahmoud H
Möhlenbruch, Markus A
Olive-Gadea, Marta
Puri, Ajit S
Sakai, Nobuyuki
Klein, Piers
Tomppo, Liisa
Caparros, Francois
Ramos, João Nuno
Jumaa, Mouhammad
Zaidi, Syed
Dobrocky, Tomas
Martinez-Majander, Nicolas
Nannoni, Stefania
Bellante, Flavio
Rodriguez-Calienes, Aaron
Salazar-Marioni, Sergio
Virtanen, Pekka
Kaiser, Daniel Po
Ventura, Rita
Jesser, Jessica
Castonguay, Alicia C
Qureshi, Muhammad M
Masoud, Hesham E
Galecio-Castillo, Milagros
Requena, Manuel
Lauha, Riikka
Hu, Wei
Lin, Eugene
Miao, Zhongrong
Roy, Daniel
Yamagami, Hiroshi
Seiffge, David J
Strambo, Davide
Ringleb, Peter A
Lemmens, Robin
Fischer, Urs
Nguyen, Thanh N
Kaesmacher, Johannes
Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
Document Type
Publication Date
Subject Area
Collections
Embargo Expiration Date
Link to Full Text
Abstract
Introduction: The benefit of endovascular therapy (EVT) among stroke patients with large ischemic core (ASPECTS 0-5) in the extended time window outside of trial settings remains unclear. We analyzed the effect of EVT among these stroke patients in real-world settings.
Patients and methods: The CT for Late Endovascular Reperfusion (CLEAR) study recruited patients from 66 centers in 10 countries between 01/2014 and 05/2022. The extended time-window was defined as 6-24 h from last-seen-well to treatment. The primary outcome was shift of the 3-month modified Rankin scale (mRS) score. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. Outcomes were analyzed with ordinal and logistic regressions.
Results: Among 5098 screened patients, 2451 were included in the analysis (median age 73, 55% women). Of patients with ASPECTS 0-5 (n = 310), receiving EVT (n = 209/310) was associated with lower 3-month mRS when compared to medical management (median 4 IQR 3-6 vs 6 IQR 4-6; aOR 0.4, 95% CI 0.2-0.7). Patients undergoing EVT had higher sICH (11.2% vs 4.0%; aOR 4.1, 95% CI 1.2-18.8) and lower mortality (31.6% vs 58.4%, aOR 0.4; 95% CI 0.2-0.9) compared to medically managed patients. The relative benefit of EVT was comparable between patients with ASPECTS 0 and 5 and 6-10 in the extended time window (interaction aOR 0.9; 95% CI 0.5-1.7).
Conclusion: In the extended time window, patients with ASPECTS 0-5 may have preserved relative treatment benefit of EVT compared to patients with ASPECTS 6-10. These findings are in line with recent trials showing benefit of EVT among real-world patients with large ischemic core in the extended time window.
Trial registration number: clinicaltrials.gov; Unique identifier: NCT04096248.
Source
Mujanovic A, Strbian D, Demeestere J, Marto JP, Puetz V, Nogueira RG, Abdalkader M, Nagel S, Raymond J, Ribo M, Michel P, Yoshimura S, Zaidat OO, Winzer S, Ortega-Gutierrez S, Sheth SA, Siegler JE, Dusart A, Haussen DC, Henon H, Serrallach BL, Mohammaden MH, Möhlenbruch MA, Olive-Gadea M, Puri AS, Sakai N, Klein P, Tomppo L, Caparros F, Ramos JN, Jumaa M, Zaidi S, Dobrocky T, Martinez-Majander N, Nannoni S, Bellante F, Rodriguez-Calienes A, Salazar-Marioni S, Virtanen P, Kaiser DP, Ventura R, Jesser J, Castonguay AC, Qureshi MM, Masoud HE, Galecio-Castillo M, Requena M, Lauha R, Hu W, Lin E, Miao Z, Roy D, Yamagami H, Seiffge DJ, Strambo D, Ringleb PA, Lemmens R, Fischer U, Nguyen TN, Kaesmacher J. Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke. Eur Stroke J. 2024 May 17:23969873241249406. doi: 10.1177/23969873241249406. Epub ahead of print. PMID: 38757713.